Safe use of platelet GP IIb/IIIa inhibitors☆,☆☆,★
Section snippets
Bleeding
In the EPIC trial,1 2099 patients scheduled for high-risk PTCA or directional coronary atherectomy were randomly assigned to receive an abciximab bolus and 12-hour intravenous (IV) abciximab infusion, an abciximab bolus and placebo infusion, or a placebo bolus and placebo infusion.1, 2, 3 All patients also received standard aspirin pretreatment and intra- and postprocedure heparin. The most frequent adverse event was bleeding, usually at vascular access sites in the groin (Table I).1
Recommendations to reduce bleeding risk
Since the original EPIC report, additional clinical trials (CAPTURE, EPILOG) and empiric observations have expanded our understanding of the safety of abciximab in general clinical usage outside the confines of rigidly structured clinical trials. These data have demonstrated that fairly simple strategies can substantially reduce the risk of bleeding complications with GP IIb/IIIa receptor inhibitors. Prudent measures can reduce preprocedure risk factors, enhance procedure safety, and optimize
Recommendations for specific clinical situations
As clinical experience with abciximab has grown, a number of patient management issues have arisen. Some of the most commonly encountered and clinically vexing are discussed below, along with specific recommendations. Note that there are limited trial data to guide these recommendations, which are based heavily on empiric evidence; these recommendations are not part of the current product package insert.
Conclusions
Clinical trials have demonstrated that platelet GP IIb/IIIa-targeted therapy safely and effectively reduces the risk of ischemic complications in patients undergoing PTCA. The following safety-related observations on the clinical use of GP IIb/IIIa receptor inhibitors in the setting of coronary intervention are based on experience to date with abciximab.
(1) Bleeding, typically at the site of vascular access, is a potential risk of abciximab treatment, but the risk can be dramatically reduced
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Cited by (0)
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From the aTexas Heart Institute, Houston; the bCarl and Edyth Lindner Center for Clinical Cardiovascular Research, Cincinnati; cRoyal Victoria Hospital, Belfast; dUniversity of Edinburgh; eVanderbilt Medical Center, Nashville; fUniversity Hospital Basel; gServizio di Cardiologia, Verona.
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Reprint requests: James J. Ferguson, MD, Cardiology Research, MC 1-191, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345.
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